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    Case Report Presentation of Ultrasound-guided Erector Spinae Plane Block in Shoulder Surgery: Three Patients and Two Different Results
    (CUREUS INC, 2018) Selvi, Onur; Tulgar, Serkan; Ozer, Zeliha
    Erector spinae block (ESPB) is an effective therapy for chronic shoulder pain. However, ESPB has not been used as a postoperative analgesia method in shoulder surgeries. In this case report, we report three patients undergoing shoulder surgeries that received ESPB preoperatively for postoperative analgesia. All patients had relief of preoperative pain and no associated motor block. Two of the patients manifested with low maximum pain scores (4/10, 3/10) on a numeric rating scale (NRS). The other patient reported a maximum pain score of 8/10 on NRS. While this patient's shoulder mobility immediately improved after ESPB application, the ESPB did not provide adequate analgesia for the postoperative period. The use of the ESPB for acute postoperative analgesia after shoulder surgery is novel and clinically interesting. However, postoperative analgesia was not completely opioid-sparing. Consequently, the efficiency of ESPB at the level of T2 for postoperative analgesia should be considered for surgeries that involve the shoulder cap given the possible inadequate migration of local anesthetic into the cervical plexus. Clinicians should carefully consider an ESPB as a postoperative analgesic option when considering shoulder operations and the possibility for the incomplete spread of local anesthetic in targeted neural structures.
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    Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries
    (ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Selvi, Onur; Senturk, Ozgur; Ermis, Mehmet Nurullah; Cubuk, Rahmi; Ozer, Zeliha
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    Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2018) Tulger, Serkan; Ermis, Mehmet Nurullah; Ozer, Zeliha
    Femur neck fractures may occur in elderly patients with multiple co-morbidities. Spinal or general anaesthesia may not be safe in such patients, leading to a search for other safer alternatives. Herein, we report a case in which a never previously reported combination of quadratus lumborum block (QLB) and erector spinae plane block (ESPB) was successfully used as the main anaesthetic method for hemiarthroplasty. An 86-year-old female patient with severe aortic stenosis was scheduled for internal fixation or hemiarthroplasty due to right femoral neck fracture. Following sedoanalgesia, the patient was placed in lateral decubitis position and ESPB and transmuscular QLB were performed from the fourth lumbar vertebra level. Adequate and effective surgical anaesthesia was achieved and hemiarthroplasty was performed. The combination of lumbar ESPB and QLB can be used for the anaesthesia management in high-risk patients undergoing hemiarthroplasty.
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    Erector spinae plane block as the main anesthetic method for peri-paravertebral area surgical procedure
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Yildirim, Aziz; Karaoglan, Alper; Ozer, Zeliha
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    Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study
    (ELSEVIER SCIENCE INC, 2017) Selvi, Onur; Kahraman, Tugce; Senturk, Ozgur; Tulgar, Serkan; Serifsoy, Ercan; Ozer, Zeliha
    Study objective: In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Commack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation. Design: Prospective, blinded study. Setting: Maltepe University. Patients: Four hundred fifty-one patients selected randomly who underwent general anesthesia. Interventions: In this study we compared predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy. Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation. Measurements: Patient's American Society of Anesthesiology score, age and weight were recorded. TMH, TMD, MMT, ULBT, IDS and C-L scores were measured and determined. Main results: The optimal cut-off point for TMH for predicting difficult laryngoscopy was 43.5 mm and for TMD was 82.06 mm. Use of TMH <43.5 with MMT has the highest sensitivity for predicting difficult intubation (78.38) with 75.36% specificity and 97.50% negative predictive value. TMH showed sensitivity of 91.89% and specificity 52.17% at 50 mm cut-off value. In the comparison of the area under the receiver operating characteristic curve values, none of the tests came forth individually or in combination with MMT test. Conclusions: The present study demonstrates the practicality of TMH as a digitalized test however the clinical benefits of TMH in daily medical practice are drawn into question. The additional variable of race may have had some bearing on this and further studies, larger in patient sample size, may need to use different methodology concerning age-, sex-, and race -dependent variables in evaluating these tests. (C) 2016 Elsevier Inc. All rights reserved.
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    Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial
    (ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Kapakli, Mahmut Sertan; Senturk, Ozgur; Selvi, Onur; Serifsoy, Talat Ercan; Ozer, Zeliha
    Study objective: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. Design: Single-blinded, prospective, randomized, efficiency study. Setting: Tertiary university hospital, postoperative recovery room & ward. Patients: 36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. Interventions: Standard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). Measurements: Pain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. Main results: NRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. Conclusion: Bilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.
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    Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Deveci, Uğur; Ozer, Zeliha; Deveci, Uğur
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    A novel modification to ultrasound guided lumbar erector spinae plane block: Tulgar approach
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Unal, Omer Kays; Thomas, David Terence; Ozer, Zeliha
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    Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Senturk, Ozgur; Selvi, Onur; Balaban, Onur; Ahiskalioglu, Ali; Thomas, David Terence; Ozer, Zeliha
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    Rhomboid intercostal block in a modified radical mastectomy and axillary curettage patient; A new indication for novel interfascial block
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Manukyan, Manuk Norayık; Ozer, Zeliha
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    Ultrasound guided rhomboid intercostal block provides effective analgesia for excision of elastofibroma extending to the subscapular space: The first report of use in anesthesia practice
    (ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Thomas, David Terence; Deveci, Uğur; Ozer, Zeliha; Deveci, Uğur
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    YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia
    (ELSEVIER SCIENCE INC, 2017) Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha
    Introduction: Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method: A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. Results: After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 +/- 4.28 vs. 5.84 +/- 2.90, p = 0.044 and 3.89 +/- 5.43 vs. 1.19 +/- 3.35, p=0.01 respectively). Conclusion: Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. (C) 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
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    YouTube as an informational source for brachial plexus blocks: evaluation of content and educational value
    (ELSEVIER SCIENCE INC, 2019) Selvi, Onur; Tulgar, Serkan; Senturk, Ozgur; Topcu, Deniz, I; Ozer, Zeliha
    Background and objectives: YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on You Tube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source. Methods: The YouTube search was performed using keywords associated with brachial plexus nerve blocks and the final 86 videos out of 374 were included in the watch list. The assessors scored the videos separately according to the Questionnaires. Questionnaire-1 (Q1) was prepared according to the ASRA guidelines/Miller's Anesthesia as a reference text book, and Questionnaire-2 (Q2) was formulated using a modification of the criteria in Evaluation of Video Media Guidelines. Results: 72 ultrasound-guided and 14 nerve-stimulator guided block videos were evaluated. In Q1, for ultrasound-guided videos, the least scores were for Q1-5 (1.38) regarding the complications, and the greatest scores were for Q1-13 (3.30) regarding the sono-anatomic image. In videos with nerve stimulator, the lowest and the highest scores were given for Q1-7 (1.64) regarding the equipment and Q1-12 (3.60) regarding the explanation of muscle twitches respectively. In Q2, 65.3% of ultrasound-guided and 42.8% of blocks with nerve-stimulator had worse than satisfactory scores. Conclusions: The majority of the videos examined for this study lack the comprehensive approach necessary to safely guide someone seeking information about brachial plexus nerve blocks. (C) 2018 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.